title: Risk factors associated with sleep disturbance following traumatic brain injury: clinical findings and questionnaire based study.
abstract: BACKGROUND
  Sleep disturbance is very common following traumatic brain injury (TBI), which may initiate or exacerbate a variety of co-morbidities and negatively impact rehabilitative treatments. To date, there are paradoxical reports regarding the associations between inherent characteristics of TBI and sleep disturbance in TBI population. The current study was designed to explore the relationship between the presence of sleep disturbance and characteristics of TBI and identify the factors which are closely related to the presence of sleep disturbance in TBI population.
  
  
  METHODS
  98 TBI patients (72 males, mean age ± SD, 47 ± 13 years, range 18-70) were recruited. Severity of TBI was evaluated based on Glasgow Coma Scale (GCS). All participants performed cranial computed tomography and were examined on self-reported sleep quality, anxiety, and depression.
  
  
  RESULTS
  TBI was mild in 69 (70%), moderate in 15 (15%) and severe in 14 (15%) patients. 37 of 98 patients (38%) reported sleep disturbance following TBI. Insomnia was diagnosed in 28 patients (29%) and post-traumatic hypersomnia in 9 patients (9%). In TBI with insomnia group, 5 patients (18%) complained of difficulty falling asleep only, 8 patients (29%) had difficulty maintaining sleep without difficulty in initial sleep and 15 patients (53%) presented both difficulty falling asleep and difficulty maintaining sleep. Risk factors associated with insomnia were headache and/or dizziness and more symptoms of anxiety and depression rather than GCS. In contrast, GCS was independently associated with the presence of hypersomnia following TBI. Furthermore, there was no evidence of an association between locations of brain injury and the presence of sleep disturbance after TBI.
  
  
  CONCLUSIONS
  Our data support and contribute to a growing body of evidence which indicates that TBI patients with insomnia are prone to suffer from concomitant headache and/or dizziness, report more symptoms of anxiety and depression and severe TBI patients are likely to experience hypersomnia.
authors.affiliation: Department of Neurosurgery, Shanghai Institute of Neurosurgery, PLA Institute of Neurosurgery, Changzhang Hospital, Second Military Medical University, Shanghai, China.
authors.forename: Lijun
authors.initials: L
authors.lastname: Hou
authors.forename: Xi
authors.initials: X
authors.lastname: Han
authors.forename: Ping
authors.initials: P
authors.lastname: Sheng
authors.forename: Wusong
authors.initials: W
authors.lastname: Tong
authors.forename: Zhiqiang
authors.initials: Z
authors.lastname: Li
authors.forename: Dayuan
authors.initials: D
authors.lastname: Xu
authors.forename: Mingkun
authors.initials: M
authors.lastname: Yu
authors.forename: Liuqing
authors.initials: L
authors.lastname: Huang
authors.forename: Zhongxin
authors.initials: Z
authors.lastname: Zhao
authors.forename: Yicheng
authors.initials: Y
authors.lastname: Lu
authors.forename: Yan
authors.initials: Y
authors.lastname: Dong
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D001930:Brain Injuries / Q000150:complications*; D005260:Female; D015600:Glasgow Coma Scale; D006801:Humans; D008297:Male; D008875:Middle Aged; D012307:Risk Factors; D057566:Self Report; D012893:Sleep Wake Disorders / Q000453:epidemiology* / Q000209:etiology*; D011795:Surveys and Questionnaires; D055815:Young Adult